Chronic Abdominal Wall Pain: A Poorly Recognized Clinical Problem

Abstract

Chronic abdominal wall pain is easily diagnosed on physical examination and can often be rapidly treated. Any physician treating patients with abdominal pain should be aware of this condition. Further comparative treatment trials will be needed before a validated treatment algorithm can be established.

Anterior cutaneous nerve entrapment syndrome: management challenges

“…Chronic abdominal wall pain might have variable etiologies, and thus it requires thorough clinical and laboratory investigations 1,2. Abdominal cutaneous nerve entrapment syndrome (ACNES) is one of the causes of chronic abdominal pain, which is mostly underdiagnosed and not appropriately treated 2.…”

“…Abdominal cutaneous nerve entrapment syndrome (ACNES) is one of the causes of chronic abdominal pain, which is mostly underdiagnosed and not appropriately treated 2. In this syndrome, the cutaneous branches of the lower thoracoabdominal intercostal nerves are entrapped at the lateral border of the rectus abdominis muscle, resulting in a severe, often refractory, chronic pain 1.…”

“…In this syndrome, the cutaneous branches of the lower thoracoabdominal intercostal nerves are entrapped at the lateral border of the rectus abdominis muscle, resulting in a severe, often refractory, chronic pain 1. The prevalence of the syndrome ranges between 15% and 30% depending on the definition and the diagnostic criteria used 2–6. In adolescents, it is reported to be diagnosed in one out of eight cases of chronic abdominal pain 3,7.…”

“…Some authors have suggested that the entrapment is usually caused by this sudden turn in their course into the rectus abdominis channel, leading to ACNES 1,7. The muscle contraction at this location may cause additional nerve compression, and therefore mechanical or ischemic irritation, which results in severe pain 1,2,4…”

“…Differential diagnosis is very broad and should include all other causes of chronic abdominal pain 1,2,10–12. The entrapment or irritation of abdominal cutaneous nerves by scars, postoperative adhesions, or hernias, as well as all other types of neuropathies should be excluded.…”